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Individual

DR. LUCIANO JO SARABOSING JR.

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
M.D.

Contact information

Practice address
2108 N LAURENT ST, VICTORIA, TX 77901-5451
(361) 578-3604
(361) 576-4397
Mailing address
806 CHARLESTON DR, VICTORIA, TX 77904-3822
(361) 574-8553
(361) 574-8583

Taxonomy

Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
J7177
TX

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
0038MN
BLUECROSSS BLUESHIELD
TX
05
135718809
TX
01
16758440
DRIVER'S LICENSE
TX
05
170867901
TX
05
170867902
TX
01
45D1037942
CLIA
TX
01
J7177
STATE MEDICAL LICENSE
TX
01
N0089582
TEXAS CONTROLLED SUBSTANC
TX
Enumeration date
05/28/2006
Last updated
03/07/2023
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